Provider Demographics
NPI:1205832755
Name:SHYMANSKY, J STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:J STEPHEN
Middle Name:
Last Name:SHYMANSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 NORTHERN PIKE STE 700
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2184
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:3824 NORTHERN PIKE STE 300
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2175
Practice Address - Country:US
Practice Address - Phone:412-856-5335
Practice Address - Fax:412-856-7720
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045418E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01195309Medicaid
PAE36344Medicare UPIN
PA594943Medicare PIN
PA01195309Medicaid
PA594943Medicare ID - Type Unspecified